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Psychotic depression: symptoms, causes and treatments

Psychotic depression: symptoms, causes and treatments

January 29, 2023

Alterations or psychological illnesses tend to modify or alter the way in which people perceive themselves and their environment. Sometimes, this distortion can be so serious that a condition such as depression eventually presents symptoms of a psychosis.

This is what happens with psychotic depression , an uncommon subtype of depression that we will discuss throughout this article and that may appear in people who have already been affected by several episodes of major depression.

  • Related article: "Are there several types of depression?"

What is psychotic depression?

Psychotic depression, also known as depressive psychosis, is a subtype of depression that occurs when a severe depression includes within its symptom picture some form of psychosis . According to statistical data, this type of psychotic depression usually affects approximately one in four people who are admitted to a hospital with a diagnosis of depression.


Psychosis in depression can manifest itself through hallucinations of any kind, such as voices that tell the person that it has no value; Delusions in the form of intense feelings of uselessness and failure or directly provoke in the patient a total break with reality.

As we can see, although they are symptoms of a psychotic illness, the content of these is strongly related to some of the features of depression, such as low self-esteem .

Although psychotic depression forms a diagnostic qualification by itself, it can also appear in the context of a bipolar disorder or a major depressive disorder. In addition, due to its similarities, it is very commonly confused with a schizoaffective disorder. However, this diagnosis requires the presence of purely psychotic symptoms for at least two weeks. That is, without depressive symptoms or mood.


Regarding unipolar psychotic depression, requires that psychotic symptoms manifest only during episodes of major depression . The diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) indicate that, for the correct diagnosis of psychotic depression, the patient must meet the requirements for a major depressive episode, together with the criteria for the specifier of " psychotic characteristics. "

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How is it different from other psychoses?

Traditionally, it is understood that a person who suffers from some type of psychosis is a person who is out of touch with reality. These patients can hear voices or present strange and illogical ideas , among many other symptoms.


When these symptoms are part of a diagnosis of psychotic depression, they usually behave like fits of anger and anger for no apparent reason, sleeping during the day to stay awake all night, neglecting their image and body hygiene and even, Difficulty communicating with other people .

On the other hand, people suffering from other types of mental illnesses, such as schizophrenia, also experience psychotic symptoms. However, in psychotic depression delusions or hallucinations are consistent with the arguments of depression. While the content of the psychotic symptoms of schizophrenia is often strange and implausible and without any apparent relationship to a state of mind.

In addition, in psychotic depression patients often feel ashamed of their thoughts, so they try to hide them. Hence, this type of depression is a bit difficult to diagnose. However, an accurate diagnosis is very important , since, in addition to influencing treatment, episodes of psychotic depression are a risk factor in the development of a bipolar disorder with recurrent episodes of psychotic depression, mania and even suicide.

What symptoms does it present?

People with psychotic depression experience the symptoms of a major depressive episode, including: feelings of hopelessness, worthlessness or guilt, constant fatigue, social withdrawal and agitation and irritability; accompanied by one or more psychotic symptoms including delusions and hallucinations.Also, the patient may also have any of the following symptoms:

  • Severe anhedonia.
  • Psychomotor retardation .
  • Anxiety.
  • Constipation.
  • Hypochondria.
  • Insomnia .
  • Physical immobility.

What are the causes?

Although, for the time being, it has not been determined what exact factors cause the development of a psychotic depression, it has been observed that the psychotic symptoms tend to develop after the person has gone through several episodes of depression without psychosis. Also, once these psychotic symptoms appear, they tend to reappear in every future depressive episode .

It has also been observed that families in which some of its components have experienced a psychotic depression have a higher risk of both psychotic depression and schizophrenia. This points to a possible genetic component of this disease.

A large number of patients with psychotic depression report having experienced an initial episode of depression between 20 and 40 years. In the same way that happens with other types of depression, psychotic depression is also usually episodic, with symptoms that appear over a period of time determined and diminish with time. Further, these people tend to function well both socially and professionally between depressive episodes .

Finally, although psychotic depression can be considered chronic when it lasts for more than two years, most depressive episodes have a duration of less than 24 months.

What is the treatment and prognosis?

Usually, the treatment of psychotic depression is carried out in a hospital environment, so that the patient can be monitored to ensure maximum safety.

It is usually done a pharmacological treatment accompanied by psychological therapies that facilitate the integration of the patient in their environment. In pharmacological treatment, combinations of antidepressants and antipsychotic medications are often used.

While antidepressants favor the stabilization of mood, antipsychotics allow the brain to be able to perceive and organize the information surrounding the person.

An adequate treatment for psychotic depression can be really effective, even to the point of allowing the patient to recover within a period of several months. However, due to the episodic nature of the disease, it is necessary to have a continuous medical follow-up .

In the most severe cases or those that do not respond to pharmacological treatment, the application of electroconvulsive therapy may be necessary.

As for the prognosis of this disease, it tends to be much more positive than other psychiatric diagnoses such as schizoaffective disorders. Even so, people who experience a psychotic depressive episode have more chances of relapse and suicide . Hence the need for tight monitoring.


Psychosis - causes, symptoms, and treatment explained (January 2023).


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